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섬망 환자에서 Amisulpride의 유효성 및 내약성에 관한 예비 연구

Preliminary Study on the Efficacy and Tolerability of Amisulpride in Patients with Delirium

이종훈|최태영|원승희|손효경|강승걸|박종한
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2011.06|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제17권 제1호|pp. 104-111

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섬망·비정형 항정신병 약물·AmisulprideDelirium · Atypical antipsychotics · Amisulpride
주제분류정신과학

초록

Objectives：Delirium is a disorder that needs active treatments since it is associated with poor outcomes such as comorbidity, longer hospital stay, higher mortality rate, higher rates of institutional care and dementia. This study was done to investigate the efficacy and safety of amisulpride, a atypical antipsychotic drug that is in possession of distinguishable pharmacodynamic profile characteristics from other widely used atypical antipsychotic drugs, but it has characteristics that are most similar to haloperidol which was the most commonly used antipsychotic drug treating patients with delirium in a safe manner. Methods：We recruited 19 delirium patients. Korean version of Delirium Rating Scale-Revised-98(K-DRS-R-98) and Korean version of Delirium Rating Scale(K-DRS) had been used to measure severity and improvement of delirium symptoms. Clinical Global Impression Severity Score(CGI-S) had been used to examine general medical conditions in the patients. The assessment on side effects began from day 2 for every visit to patients using Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS). Results：A total of 14 patients completed the study. They were administered with mean amisulpride dose 86.16 (SD=39.01) mg per day. The K-DRS scores were decreased from 21.57±4.72 before the treatment to 7.14±0.84 after the treatment(p＜0.01). The K-DRS-R-98 scores also were significantly decreased from 25.07±6.40 before the treatment to 9.93±1.09 after the treatment(p＜0.01). Among detailed K-DRS-R-98 scale items, the sleep item also showed a significant decrease(p＜0.01). There was no patient who suffered serious side effects. In 35.7% of the patients, the mild rigidity and mild tremor of extrapyramidal symptoms occurred. Conclusion：Amisulpride is expected to be used effectively and safely in treating delirium patients

Abstract

Objectives：Delirium is a disorder that needs active treatments since it is associated with poor outcomes such as comorbidity, longer hospital stay, higher mortality rate, higher rates of institutional care and dementia. This study was done to investigate the efficacy and safety of amisulpride, a atypical antipsychotic drug that is in possession of distinguishable pharmacodynamic profile characteristics from other widely used atypical antipsychotic drugs, but it has characteristics that are most similar to haloperidol which was the most commonly used antipsychotic drug treating patients with delirium in a safe manner. Methods：We recruited 19 delirium patients. Korean version of Delirium Rating Scale-Revised-98(K-DRS-R-98) and Korean version of Delirium Rating Scale(K-DRS) had been used to measure severity and improvement of delirium symptoms. Clinical Global Impression Severity Score(CGI-S) had been used to examine general medical conditions in the patients. The assessment on side effects began from day 2 for every visit to patients using Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS). Results：A total of 14 patients completed the study. They were administered with mean amisulpride dose 86.16 (SD=39.01) mg per day. The K-DRS scores were decreased from 21.57±4.72 before the treatment to 7.14±0.84 after the treatment(p＜0.01). The K-DRS-R-98 scores also were significantly decreased from 25.07±6.40 before the treatment to 9.93±1.09 after the treatment(p＜0.01). Among detailed K-DRS-R-98 scale items, the sleep item also showed a significant decrease(p＜0.01). There was no patient who suffered serious side effects. In 35.7% of the patients, the mild rigidity and mild tremor of extrapyramidal symptoms occurred. Conclusion：Amisulpride is expected to be used effectively and safely in treating delirium patients

참고문헌 (62)

  1. "American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders(DSM-IV) 4th edition" (1994), American Psychiatric Association
  2. Trzepacz PT, "Practice guideline for the treatment of patients with delirium", Am J Psychiatry, 156, pp.1~20 (1999)
  3. Lipowski ZJ, "Delirium(acute confusional states)", JAMA, 258, pp.1789~1792 (1987)
  4. Young J, "Delirium in older people", BMJ, 334, pp.842~846 (2007)
  5. Siddiqi N, "Occurrence and outcome of delirium in medical in-patients:a systematic literature review", Age Ageing, 35, pp.350~364 (2006)
  6. Girard TD, "Delirium in the intensive care unit", Crit Care, 12(Suppl 3), pp.S3~ (2008)
  7. Cole MG, "Prognosis of delirium in elderly hospital patients", CMAJ, 149, pp.41~46 (1993)
  8. Witlox J, "Delirium in elderly patients and the risk of postdischarge mortality,institutionalization,and dementia:a meta-analysis", JAMA, 304, pp.443~451 (2010)
  9. Varsamis J, "Survival rates and causes of death in geriatric psychiatric patients.A six-year follow-up study", Can Psychiatr Assoc J, 17, pp.17~22 (1972)
  10. van der Mast RC, "Delirium:the underlying pathophysiological mechanisms and the need for clinical research", J Psychosom Res, 41, pp.109~113 (1996)
  11. Kim HS, "Pathophysiology of deliri", J Korean Soc Biol Ther Psychiatry, 5, pp.65~77 (1999)
  12. Trzepacz PT, "Advances in diagnosis,pathophysiology,and treatment", Psychiatr Clin North Am, 19, pp.429~448 (1996)
  13. Trzepacz PT, "Update on the neuropathogenesis of delirium", Dement Geriatr Cogn Disord, 10, pp.330~334 (1999)
  14. Trzepacz PT, "Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine", Semin Clin Neuropsychiatry, 5, pp.132~148 (2000)
  15. Itil T, "Anticholinergic drug-induced delirium:experimental modification,quantitative EEG and behavioral correlations", J Nerv Ment Dis, 143, pp.492~507 (1966)
  16. Ames D, "Organic mental disorders associated with bupropion in three patients", J Clin Psychiatry, 53, pp.53~55 (1992)
  17. Miller MO, "Evaluation and management of delirium in hospitalized older patients", Am Fam Physician, 78, pp.1265~1270 (2008)
  18. Schwartz TL, "The role of atypical antipsychotics in the treatment of delirium", Psychosomatics, 43, pp.171~174 (2002)
  19. Carnes M, "Physicians vary in approaches to the clinical management of delirium", J Am Geriatr Soc, 51, pp.234~239 (2003)
  20. Tune L, "The role of antipsychotics in treating delirium", Curr Psychiatry Rep, 4, pp.209~212 (2002)
  21. Practice guideline for the treatment of patients with delirium, "American Psychiatric Association", Am J Psychiatry, 156, pp.1~20 (1999)
  22. Miyaji S, "comparison of the risk of adverse events between risperidone and haloperidol in delirium patients", Psychiatry Clin Neurosci, 61, pp.275~282 (2007)
  23. Seitz DP, "Antipsychotics in the treatment of delirium:a systematic review", J Clin Psychiatry, 68, pp.11~21 (2007)
  24. Akechi T, "Usage of haloperidol for delirium in cancer patients", Support Care Cancer, 4, pp.390~392 (1996)
  25. Rea RS, "Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients", Pharmacotherapy, 27, pp.588~594 (2007)
  26. Schwarts TL, "The role of atypical antipsychotics in the treatment of delirum", Psychosomatics, 43, pp.171~174 (2002)
  27. Horikawa N, "Treatment for delirium with risperidone:results of a prospective open trial with 10 patients", Gen Hosp Psychiatry, 25, pp.289~292 (2003)
  28. Mittal D, "Risperidone in the treatment of delirium:results from a prospective open-label trial", J Clin Psychiatry, 65, pp.662~667 (2004)
  29. Han CS, "A DOUBLE-BLIND TRIAL OF RISPERIDONE AND HALOPERIDOL FOR THE TREATMENT OF DELIRIUM", PSYCHOSOMATICS, 45, pp.297~301 (2004)
  30. Shingo M, "comparison of the riskk of adverse events between risperidone and haloperidol in delirum patients", Psychiatry Clin Neurosci, 61, pp.275~282 (2007)
  31. Breitbart W, "An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients", Psychosomatics, 43, pp.175~182 (2002)
  32. Kim KS, "An open pilot trial of olanzapine for delirium in the Korean population", Psychiatry Clin Neurosci, 55, pp.515~519 (2001)
  33. Kim KY, "Treatment of delirium in older adults with quetiapine", J Geriatr Psychiatry Neurol, 16, pp.29~31 (2003)
  34. Pae CU, "A pilot trial of quetiapine for the treatment of patients with delirium", Hum Psychopharmacol, 19, pp.125~127 (2004)
  35. Leso L, "Ziprasidone treatment of delirium", Psychosomatics, 43, pp.61~62 (2002)
  36. Young CC, "Intravenous ziprasidone for treatment of delirium in the intensive care unit", Anesthesiology, 101, pp.794~795 (2004)
  37. Lee KU, "Amisulpride versus quetiapine for the treatment of delirium:a randomized,open prospective study", Int Clin Psychopharmacol, 20, pp.311~314 (2005)
  38. Pintor L, "Study on the efficacy and tolerability of amisulpride in medical", surgical inpatients with delirium admitted to a general hospital, 2009, pp.24, 450~455
  39. Alao AO, "Aripiprazole in the treatment of delirium", Int J Psychiatry Med, 35, pp.429~433 (2005)
  40. Straker DA, "Aripiprazole in the treatment of delirium", Psychosomatics, 47, pp.385~391 (2006)
  41. Seeman P, "Atypical antipsychotics:mechanism of action", Can J Psychiatry, 47, pp.27~38 (2002)
  42. Hans-Jurgen M, "Amisulpride:limbic specificity and the mechanism of antipsychotic activity", Prgogress in Neuro-Psychopharmacology & Biological psychiatry, 27, pp.1101~1111 (2003)
  43. McKeage K, "Amisulpride:a review of its use in the management of schizophrenia", CNS Drugs, 18, pp.933~956 (2004)
  44. Inouye SK, "Clarifying confusion:the confusion assessment method.A new method for detection of delirium", Ann Intern Med, 113, pp.941~948 (1990)
  45. Trzepacz PT, "Validation of the Delirium Rating Scale-revised- 98: comparison with the delirium rating scale and the cognitive test for delirium", J Neuropsychiatry Clin Neurosci, 13, pp.229~242 (2001)
  46. Guy W, "Clinical Global Impression(CGI)Modified From, in Handbook of psychiatry Measures", pp.100~102 (2000), American Psychiatric Association
  47. Trzepacz PT, "A symptom rating scale for delirium", Psychiatry Res, 23, pp.89~97 (1988)
  48. 이양현, "한국판 섬망 평가 척도의 표준화", 생물치료정신의학, 9(2), pp.181~190 (2003), 대한생물치료정신의학회
  49. 임경옥, "한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구", 신경정신의학, 45(6), pp.518~526 (2006), 대한신경정신의학회
  50. Woods SW, "Chlorpromazine equivalent doses for the newer atypical antipsychotics", J Clin Psychiatry, 64, pp.663~667 (2003)
  51. Curran MP, "Spotlight on amisulpride in schizophrenia", CNS Drugs, 16, pp.207~211 (2002)
  52. Jeste DV, "Conventional vs.newer antipsychotics in elderly patients", Am J Geriatr Psychiatry, 7, pp.70~76 (1999)
  53. Pandharipande P, "Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients", Anesthesiology, 104, pp.21~26 (2006)
  54. Pandharipande P, "Prevalence and risk factor for development of delirium in surgical and trauma ICU patients" (2007), J Tramua, in press
  55. Schwartz TL, "Treatment of Delirium With Quetiapine", Prim Care Companion J Clin Psychiatry, 2, pp.10~12 (2000)
  56. Torres R,Mittal D, "Use of quetiapine in delirium:case reports", Psychosomatics, 42, pp.347~349 (2001)
  57. Sim FH, "Quetiapine associated with acute mental status changes", Can J Psychiatry, 45, pp.299~ (2000)
  58. Richelson E, "Preclinical pharmacology of neuroleptics:focus on new generation compounds", J Clin Psychiatry 57 Suppl, 11, pp.4~11 (1996)
  59. Morita T, "Olanzapine-induced delirium in a terminally ill cancer patient", J Pain Symptom Manage, 28, pp.102~103 (2004)
  60. Lim CJ, "Can Olanzapine Cause Delirium in the Elderly", The Annals of Pharmacotherapy, 40, pp.135~138 (2006)
  61. Robinson RL, "Fever,delirium,autonomic instability,and monocytosis associated with olanzapine", J Postgrad Med, 49, pp.96~ (2003)
  62. Samuels S, "Olanzapine may cause delirium in geriatric patients", J Clin Psychiatry, 65, pp.582~583 (2004)

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